The blepharocardiac reflex
R. L. Anderson
The oculocardiac reflex is described as the triad of bradycardia, nausea,
and faintness evoked by the stretching of ocular muscles, or by pressure on
or within the eyeball. The trigeminal nerve is the afferent limb of this
reflex; the efferent limb is the vagus nerve to the heart. This reflex was
noted to occur from traction on the levator aponeurosis in five of 36
patients with ptosis, and from traction on the retractors of the lower
eyelid in three of 11 patients with entropion. To our knowledge, this is
the first documentation of eliciting this reflex by stretching the muscles
of the eyelid. Electrocardiogram monitoring for early recognition of these
cases, and the availability of an intravenous line with atropine for prompt
treatment are strongly recommended. Careful manipulation of the upper and
lower eyelid retractors and preoperative atropine therapy may help to
reduce the incidence of this reflex.
